A Multicenter Retrospective Survey of Poisoning after Consumption of Products Containing Synthetic Chemicals in Japan

Abstract

Objective We conducted a multicenter retrospective survey of patients poisoned by synthetic chemicals (SCs) in Japan. Methods Letters were sent to 467 emergency facilities requesting participation in the study, and questionnaires were mailed to facilities that agreed to participate. Patients The study participants were patients who were transported to emergency facilities between January 2006 and December 2012 after consuming SC-containing products. Results We surveyed 518 patients from 60 (12.8%) facilities. Most patients were male (82.0%), in their 20s or 30s (80.5%), and had inhaled SCs (87.5%) contained in herbal products (86.0%). Harmful behavior was observed at the scene of poisoning for 56 patients (10.8%), including violence to others or things in 32, traffic accidents in seven, and self-injury or suicide attempts in four. Other than physical and neuropsychiatric symptoms, some patients also had physical complications, such as rhabdomyolysis (10.0%). Of the 182 patients (35.1%) admitted to hospitals, including 29 (5.6%) who needed respirators, all of the 21 (4.1%) hospitalized for at least seven days were male, and 20 had physical complications (rhabdomyolysis, 12; liver dysfunction, 5; renal dysfunction, 11; and physical injuries, 3). Most patients (95.6%) completely recovered, although 10 (1.9%) were transferred to a psychiatric department or hospital, and three (0.6%) were handed over to the police due to combative or violent behavior. SCs such as synthetic cannabinoids, synthetic cathinones, or methoxetamine were detected in 20 product samples. Conclusion Consuming products containing SCs can result in physical complications, including rhabdomyolysis, injuries, and physical or neuropsychiatric symptoms, which may require active interventions, such as respirator use or prolonged hospitalization.

Differences in sociodemographic characteristics, clinical features and serum liver function tests of male cannabis and synthetic cannabinoid users

“…Nevertheless, this similarity does not mean C and SCs have similar risks, regarding that clinical cases with serious adverse effects and deaths related with SCs reported in the literature. 4,5,9,10,12,18 The relative risk associated with the use of SCs was found to be 30 times higher than that associated with C; and significantly more symptoms were reported by respondents seeking treatment for SCs than for C. 10 Although both Δ-tetrahydrocannabinol and SCs stimulate the same receptors (CB1 and CB2); studies have shown that SCs are associated with higher rates of toxicity and hospital admissions than natural C. 6 This is likely due to SCs being direct agonists of the cannabinoid receptors, whereas C is a partial agonist. Furthermore, the different chemical structures of SCs may interact in unpredictable ways to elicit previously unknown effects, also the commercial products may have unknown contaminants.…”

“…3,7 SCs have full agonistic effect on both central nervous system cannabinoid type 1 (CB1) and type 2 (CB2) receptors, whereas C is a partial agonist of these receptors. 5,8 As a result, SCs potentially pose a greater risk to users' health than natural forms of C. 9,10 Abuse of SCs has been shown to produce serious adverse health effects, including but not limited to hyperactive delirium, psychotic episodes, acute kidney injury, seizures, stroke, myocardial infarctions, and even occasional deaths. 5,11,12 In addition to adverse effects, withdrawal symptoms such as agitation, irritability, anxiety, mood swings, nausea, loss of appetite, sweating and headache were reported by SC abusers.…”

Socio-demographic and Clinical Features of Young Adult Males Using Synthetic Cannabinoid (English)

“…Similarly, dramatic increase have been seen in intoxication cases due to use of SC in Japan in the last few years. As well as physical complications, behavioral pathologies and psychotic symptoms were also observed in these cases (5). In US National Poison Data System records of 2015, serious side effects has been found in 11.3% of the acute intoxication cases due to SC use (4).…”

“…While it was found that users in Europe and the US are mostly adolescent and young adult males (1,6), SC using age in Japan was reported to be higher when compared to Western countries (5). It was found in studies that the use of other psychoactive substances with SC is common and the most commonly used psycho-active agents are alcohol and cannabis (7).…”

“…Similarly, Bonar et al determined that patients with long-term SC use had higher frequency for the use of other substances and had more severe depression (8). Anxiety and panic attacks have been reported to occur frequently associated with the use of SC (2,5,22).…”